wierzbowski - papal visit interprofessional nyupdate ... 7 ob patient access: process map command...
TRANSCRIPT
6/13/2016
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The Papal VisitA Health System Experience
Mary Del Guidice, MSN, BS, RN, CENPChief Nursing OfficerAssistant Dean for Clinical Practice,University of PennsylvaniaSchool of Nursing
John Wierzbowski, MSc, MPH, CHEPDirector, Safety & Emergency ManagementChair, SEPA Healthcare Coalition
Outline
• Mission and Vision
• Leadership and Preparation Framework
• Impact
• Caring for our Patients
• Caring for our Staff
• Outcomes and Lessons Learned
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Papal Visit Planning Team:Patients FIRST at the Nation’s FIRST!
Vision:Provide a seamless patient care experience and support the Pennsylvania
Hospital team throughout the unprecedented event of the papal visit.
Goal:Create a comprehensive plan which considers and addresses all aspects ofcare, operations, logistics and communication throughout the papal visit.
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Penn Medicine Papal Preparation Executive Team
Executive Sponsor: Garry Scheib, Chief Operating Officer UPHS & Executive Director HUP
Leader: Bernie Dyer, Director, Safety & Emergency Management, Penn Medicine
Pennsylvania Hospital: PAH Lead: Mary Del Guidice, MSN, BS, RN, CENP, Chief Nursing Officer,PAH Co-Leader: John Wierzbowski, MSc, MPH, Manager, Safety & Emergency Management
Hospital of the University of Pennsylvania: Carolyn Jackson, Chief Operating OfficerJeffrey Henne, CHSP-FSM, CHEP, SASHE, Interim Safety Manager
Penn Presbyterian Hospital: Bob Russell, MS, FACHE, NHA, Associate Executive Director for OperationsJoseph Szymanski, BS,CHEM,CHSP, Safety Manager
Chester County Hospital: John Felicetti, Director, Safety & Security
Home Care & Hospice Services: Sandra Jost, RN, MSN, PhDc, Chief Nursing Officer & Associate Executive Director
Clinical Practices of the University of Pennsylvania: Elizabeth Johnston, Executive DirectorJohn Sestito, MSN, RRT, Associate Executive Director
Clinical Care Associates: Angela Wurster, Chief Operating Officer
Good Sheppard Penn Partners: Laura Porter, Executive Director
Penn Medicine at Rittenhouse: Joseph Cooney, Assistant Executive Director
Physician Support: P.J. Brennan, MD, Chief Medical Officer and Sr. Vice President, Penn Medicine
Human Resources; Patricia Wren, Vice President, Human Resources, Penn MedicineDebbie Foster, Director of Communications, Organization Development
Materials Management: Wayne Smith, Vice President, Corporate Materials Management
Communication/Public Affairs: Susan Phillips, Senior Vice President for Public Affairs & Senior Advisor to the Dean
Information Technology: Theresa Hiltunen, Interim Information Officer, PAHJohn Donahue, Associate Chief Information Officer, Penn Medicine - Enterprise Infrastructure Services
Penn Police: Michael Fink, Deputy Chief, Penn Police
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Pennsylvania Hospital Papal Visit Planning Team
Executive: Sponsor: Theresa Larivee MBA, Chief Executive Officer
PAH Lead: Mary Del Guidice, MSN, BS, RN, CENP, Chief Nursing OfficerCo-Lead: John Wierzbowski, Manager, Safety & Emergency Management
• Frank Anastasi, FHFMA, MBA, Chief Financial Officer
• Michael Altman, BA, Education Coordinator, Nursing Education
• Bryan Anthony, MHS, Director, Security Department
• John Brennan, MSN, RN, CNHA, Clinical Director, Nursing Department
• Deborah Christopher ,MSN,RN,CPHQ , Clinical Director, Quality and Safety
• Bernard Dyer, Director, Safety & Emergency Management
• Joshua Elton, MSHRD, Human Resource Generalist, Human Resources
• Daniel Feinberg, MD, Chief Medical Officer, Administration
• Olivia Fermano, Senior Medical Communications Officer, Communications
• Theresa Hiltunen, Entity Information Officer, Penn Presbyterian Medical Center
• Christopher Huot, MSN,RN,CNMC, Nurse Manager, Critical Care
• Tonya Johnson , DNP, RN, CCRN-K,NEA-BC, Clinical Director, Nursing
• Sarah Johnson, Chief Human Resource Officer
• Marybeth Lahey, MSN,RN,NEBC, Nurse Manager, 4/5/6 Preston, Nursing
• Kay Marshal, MBA, Chief Operations Officer, OB/GYN CPUP, CPUP Practices
• Margret Markunas, MBA, CNMT, Director Facilities Ops & Ambulatory Services
• Angel McCullough, MSN, MBA, CCRN, NE-BC, Clinical Director, Nursing
• Kathy Nasci, MD, Medical Director, Emergency Medicine
• Jeff O’Neill, AIA, ACHA, Director, Engineering Department
• Lisa O’Neill, MPH, BSN, CMSRN, Director, Nursing Network Center
• Danielle Parks, PHR, MSOD, Human Resources Generalist, Human Resources
• Pamela Power , DNP, ACNS-BC, Clinical Director, Nursing Department
• Feargal Roche, BA, Director, Materials Management
• Sean Rowland, CRNA, MS, Vice President, Peri-operative Services
• Joanne Ruggiero, MSN, RN, ONAC, MSRN, Nurse Manager, 6 CC
• George Shafer, MSN ,RN, NE-BC, Nurse Manager, 7 CC/ Preston
• Linda Sinisi, EIO, Information Systems Department
• Jeremy Souder, MD, Patient Safety Officer
• Rhoda Sulzbach, MSN,CRNP, ANP-BC, FNP-BC, Advanced Practice Services
• Annette Tantillo, RN, MSJ, Senior Director of Clinical Financial Services
• Leonard Umile, Performance and Retention Specialist, Human Resources
• Lisa Verseput, MSN, RN, CEN, Nurse Manager, Emergency Department
• Daniel Wilson, MBA, BSN, RN, FABC, VP Allied Health & Ambulatory Services
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Impact:
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What did this all mean?Greatest Period of Impact: September 24-28
Issue Healthcare Community PAH /Penn Medicine Impact Impact MitigationImpact
Limited or no • Vehicle Perimeters • Staff access challenges • Staff Hotelingaccess • Security Perimeters • Patient/families access • Emergency Access Point
• Pedestrian Only Areas challenges • Pre-staged and prepositioned(zones) • Limited or no access to supplies/meds
• Road Closures resources/deliveries • Pre-Staged ALS Ambulance• Congested/Closed • Urgent Transfer/Discharge • Strategic Scheduling
Highways Issues • “Bookend” Process• Public Transit • Scheduling issues • ED Surge Strategy - Minimal
Accessibility • LOS Care Treatment Area• Cancellation of Elective
Procedures Friday andMonday
• Rescheduling of proceduresprior to and after the event.
• ED Surge
City • Increased pediatric • Increased Patient Volume (i.e. • Hybrid StaffingPopulation populations ED, CRC ) Models/Diversion of InpatientSurge • Increase in special • Increased demand on services Admissions
needs populations • Communications slowness/ • Weekday “+Surge”• Limited access to interruption • 3-Tier Communication
hospitals in impacted • Internet slowness/interruption Redundancyarea • Upgraded IT Capability
• Communicationsslowness
• School closures
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The Planning Process
• Utilized Smartsheet® Software• Operations, Logistics, Finance Sections
• Work Assignments
• Medical Care Branch, Infrastructure Branch, Security Branches
• 167 Tasks assigned!!!!!
• Planning Meetings• Bi-Weekly in June-August• 2-3X per week September• UPHS Leadership Bi-Weekly June-September• Ad hoc meetings (too many to count!)
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The Planning Process - Smartsheet®
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The Planning Process - Staffing Matrix
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The Planning Process - Consequence Management
• Pre-Positioned Regional Assets
• CHEMPACK EMS Container w/Nerve Agent Autoinjectors
• (10) Newport HT-50 Adult Ventilators
• Regional Burn Dressing Carts
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The Planning Process - Patient Discharges/Transfers
• Contracted Ambulance Company• 2 ALS Ambulances• 1 Paratransit Van
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The Planning Process - Estimated Patient Encounters
• Used FEMA Estimates for Previous Events• In general, 0.3% to 1.3% will seek medical assistance• Planning assumption was 1-2 Million Population• Other Planning Assumptions
• Field Tents would absorb 80% of lower acuity patients• Attendees will walk to hospitals and numbers will vary based on
distance and events held
• Limited distance to 2 miles
Percent of Attendees Seeking Medical Assistance Stratified by Hospitalfor Events on Benjamin Franklin Parkway
Facility HUH SJH Jeff HUP Presby Pennsy
% of attendees seekingmedical assistance
47% 16% 12% 9% 8% 8%
*Assumes attendees seek medical care by proximity based on inverse square of distance
218 - 953 patient encountersover normal volume!!!!!!!!
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The Planning Process - Patient Surge
• Outpatient Ortho Practice Transforms into ED
• ED Minimal Care Area• Ability to surge up to 16 patients using private exam room each equipped with a sink and in-room computer for
documentation
• Potential to care for additional patients in shared space within the department
• Separate waiting area
• Both orthopedic treatment rooms and waiting area can be built into Epic ASAP as surge treatment zones
• Ability to register in waiting room area
• Streamlined one-directional entry and exit: see below
• Bathroom and hand washing facilities
• Ability to perform radiologic testing inside the space
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Papal Events
September 26, 2015Independence Hall: 4PM
World Meeting of Families Concert: 7PM
September 27, 2015Visit to Curran-From hold
Correctional Facility: 11AM
Celebration of Mass: 4PM
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Knowledge Center HIMS
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Patient Access and Discharge Mapping
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Patients First at the Nation’s First - Meet Alena Scurry
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OB Patient Access: Process Map
Command Centercalls Healthcare
Patient callsCommand Center at
instruction of OB
Informationobtained from
patientincludes where
they’retraveling from,make/modelof car, licenseplate numberand contactinformation
Coordination Desk(HCD) at
PhiladelphiaEmergency
Operations Center
Access pointconfirmed andall pertinent
vehicleinformation
and ETArelayed
Medical CareBranchdirector
notifies PETUof impending
arrival via two-
way radio
Command Center Patient calls Patient arrives atcalls patient Command Center PAH main entrance
Patient givenAccess point step-by-step
relayed, navigationpatient instructions via
instructed to phonecall Command
Center oncethey’re at or N on 11th,
through access Right on Pine,point Left on 8th
(againstnormal flow of
traffic)
Security greetspatient, escorts toPETU in wheelchair
Commandcenter
monitorssecurity
cameras tovisualize
patient’sarrival
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Alena Scurry
• “Everyone was great,” Alena, was featured on CBS3 Sunday night, said. “Thecommand center talked me through the process, and we got here with noproblems.”
• Once settled on the floor at PAH, Alena turned on the TV to hear the Pope speakdown on the parkway.
• “It gave me encouragement,” she told CBS3. “ I was inspired hearing him talk …God worked everything out and it was smooth sailing.”
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Employee Support
Employee Support Purpose Statement:To create a comprehensive plan which recognizes the hospital team thatwill be providing and supporting patient care during the Papal visit and
World Meeting of Families in September 2015
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Leadership Support and Staffing・ Goals:
• To ensure the appropriate leadership complement to support staff, patient care operations,
and the FEMA Incident Command Structure throughout the Papal visit
• To ensure adequate staffing and skill mix to support patient care operations during normal
and surge volumes
・ Assessment:
- Projected volume
- Required staffing
- Anticipated patient population
- Ability to surge
- Command Center roles required
- Support for employee and baggage check-in, sleeping, and showering
・ Plan:
- Identify and rectify staffing gaps
- Develop patient surge plan
- Match resources needs pre, post and during the Papal visit
- Identify process for flexing staff to patient census
- Assign Command Center Roles and communication structure
- Create employee informational packet
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Leadership Support and Staffing・ Implementation:
• Employee information sessions
- Papal intranet resource
- Fourteen 30 minute sessions held one month and one week prior to papal visit
- Presented collaboratively by a human resource, clinical, and operations leader
• Checked in 731 employees
- Conference style○ Linen pick-up
○ Shower and sleeping assignment cards
○ Baggage check
- Housed 486 employees on-site
- Deployed 437 air mattresses
- Cleaned 51 showers several times daily
• Handled 91 issues/patient related tasks
• Provided aid to medical tents
• Flexed staff to
meet organizational
needs
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Hospital Incident Command Structure
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Sleeping / Showering・ Sleep Locations
• Duncan Building
• Main Hospital
• Spruce Building
・ Criteria
• Developed per department
• Available space (60sf each)
• Staff Count / Shifts
• Patient Care Areas Left Open
・ Shower Locations
• Male: 5 Spruce
• Female: 7 Schiedt
・ Criteria
• 7AM - 11AM and 7PM - 11PM
• 20 minute timeslots
• Time per hour for cleaning
• Clean and dirty towels to be staged on each floor
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Checking In・ 1 Preston Lobby
• Voucher Pick-Up
• Linen Pick-Up
• Bag Check
Bag Drop
Check-In
You AreHere
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Employee Support
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Employee Support
All staff were provided with a welcome bag that included:• Tooth Brush• Gum• Life Savers (or other hard
candy)• Water bottle• Thank you card• Schedule of events• Bag of pretzels• Eye Mask
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Employee SupportFriday, September 25
8:30am Movie in Zubrow4:00-6:00pm Refresh station (fresh fruit/snacks)5:30-6:30pm Bingo (with prizes) in Cafeteria, desserts served8:30pm Movie in Zubrow9:00-10:00pm Bingo (with prizes) in Cafeteria, desserts served
Saturday, September 26
8:30am Movie in Zubrow9:00am-11:00pm Papal Event viewing in 9th Floor Waiting Room4:00-6:00pm Refresh station (fresh fruit/snacks)5:30-6:30pm Bingo (with prizes) in Cafeteria, desserts served8:30pm Movie in Zubrow9:00-10:00pm Bingo (with prizes) in Cafeteria, desserts served
Sunday, September 27
9:00am-11:00pm Papal Event viewing in 9th Floor Waiting Room1:00pm-11:00pm NFL Football viewing in Zubrow
(Eagles at 1pm, 4pm Game of the Week, 8pm Sunday Night Football)4:00-6:00pm Refresh station (fresh fruit/snacks)
*Dedicated quiet space available in 1st floor Spruce Waiting Room30
Employee SupportFood Services:Meal services will be available to all staff with the intention of every staffmember receiving meals daily beginning with Friday breakfast throughMonday breakfast.
• All staff received a “Papal Visit” food voucher when they registered• Provided 3,257 complimentary meals• Dinner service extended by 1 hour• Overnight meal service from 1:00am-2:30am to service off-shift staff Each
voucher was redeemable for several all inclusive meal options
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PAH Papal Visit: By the Numbers
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PAH Papal Visit: Lessons Learned
• Safety and Emergency Management
• Communications and information flow throughout the region, within the health system,and in the hospital worked well, maintaining situational awareness and a commonoperating picture before, during, and after the event for patient tracking, issue tracking, andreporting of bed capacity.
• The use of external resources for coordination of patient transfers and OB patient accessto designated access points through a secure vehicle perimeter was seamless.
• The ability to assess pre-event resources and supplies needs to match operations.This allowed for a seamless delivery of care and no patient safety issues. Vendors,contractors, public utilities, etc.
• Have an entity- and health system-level framework for management of large massgatherings and special events. This includes employee check-in, pre-event briefings,staff hoteling, showering accommodations, and surge plans that include hybrid staffingmodels.
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Lessons Learned: Leadership
• Begin with a clear vision and mission: Holdevery decision up to the mission and vision.
• Discover, amplify and bring together all thetalent in the organization.
• Be clear about role clarity and expectations.
• Trust your team.
• Provide your team with love and supportand they will ALWAYS amaze you!
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